Denial

BCBS is denying a injection for me that is being tested at Mayo clinic for off label use in order to reduce the size and stop continued cyst growth in my liver, I had a removal of 50% of my liver last year.

They are denying it and saying it’s not covered for this indication… but it’s quite literally life saving for me.

This is quite literally my last stop, before I am on the transplant list. For this medication to shrink my cysts it would buy me time to get a transplant possibly and become stronger I will not be able to operate if these continue to grow and I wait and wait on the transplant list.

Denial reason: As previously stated, we recognize you have polycystic kidney and liver disease. However, we are unable to cover long acting somatostatin analogues like Octreotide LAR under your benefit. Although clinical trials have shown that these medications may decrease the size of the liver by 6%, they have not shown that quality of life is improved. Additionally, serious side effects including infection and bleeding of cysts were reported. As such, we are unable to tell if there is an overall benefit to this therapy; it is considered unproven or "investigational" under your benefit and not covered What do I do?

submitted by /u/Either-Reputation572
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